A Case Report of Rapidly Progressing Mucinous Cystadenoma in Early Pregnancy

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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شناسه ملی سند علمی:

COBGY15_053

تاریخ نمایه سازی: 11 آبان 1398

Abstract:

Backgrounds: Introduction The incidence of ovarian cysts during pregnancy is less than 5%, and most of them are benign in nature. Adnexal masses are usually asymptomatic during pregnancy unless they reach large sizes. Diagnosis may be done incidentally during routine obstetric ultrasound examination. Mucinous cystadenoma is a multilocular and unilateral cystic benign epithelial tumor of the ovary and reaches huge sizes during pregnancy due to their hormone responsiveness. They are most common in the third to fifth decades of life and may be 20-30 cm in size. Ovarian torsion, cyst rupture, aortocaval compression, preterm labor and intrauterine growth restriction are the most common complications of the huge ovarian masses during pregnancy.Material and method : Case presentation A 18-year-old pregnant woman (gravida 1) presented to the outpatient clinic with rapidly progressing abdominal distension and sonography report for a huge multilocular abdominal mass during the 14th weeks of gestational age. The mass measures 25* 23 Cm in diameter with the left ovary origin with multiple internal septa. She underwent laparotomy for cyst resection at 16th weeks of gestational age. There was a huge ovarian cyst with smooth surface and really thin wall made us to evacuate the cyst fluid before its resection. There was 6500 ml mucinous fluid for evacuation and multiple cyst wall projections led to unilateral salpingo-oophorectomy instead of cystectomy. The appendectomy was down due to its nodularity. The pathology report was in favor of benign mucinous cystadenoma with normal appendix. She was discharged the day after surgery without any complication. The progesterone was prescribed for pregnancy support and now she is at the 22th weeks of gestational age with normal fetus growth. Result:In conclusion rapidly increasing the size of the cyst can be a sign of malignancy and an indication of surgery as took place in this case.Conclusion: There are different approaches to the adnexal masses during pregnancy. Usually; watchful waiting should be adopted unless an unexpected event such as torsion, rupture, infarction, fetal intrauterine growth impairment emerges requiring surgical intervention. We also believe that the high intra-abdominal pressure provided by the ovarian mass may lead to the preterm delivery. An elective operation during the second trimester versus conservative treatment is related to the risk of malignancy. Indeed, an emergency procedure undertaken after an expectant management did not show worse obstetric outcomes when compared with elective surgery. However, some researchers still advocate elective surgery.In conclusion rapidly increasing the size of the cyst can be a sign of malignancy and an indication of surgery as took place in this case.

Keywords:

pregnancy- mucinous cystadenoma- ovarian cyst

Authors

Fatemeh Tabatabaei

Tabriz University of Medical Sciences Department of Obstetrics Gynecology-Iran, Tabriz